Why giving birth on all-fours could be better for you

More and more research is being conducted on the benefits of upright birth positions versus the semirecumbant and lithotomy birth positions. Although the latter have been most common in the United States for the past 100 years, success stories from other countries and minorities within our own have led researchers to question the common practice.

What other countries (with lower birth mortality rates than our own) have been finding is that women who give birth upright or in the all-fours position have less pain in labor and birth, have shorter labors and pushing times, less shoulder dystocia (where the baby’s shoulders get stuck in the pelvis), and fewer perineal tears.

In addition to all of the above benefits, current American-based studies also suggest the following benefits to giving birth on hands and knees: fewer maternal and infant injuries and infant deaths related to shoulder dystocia1, less painful and more efficient contractions2, impressive rate of rotating posterior babies to anterior within 10 minutes3, shorter labor4, and the potential to decrease risk of both instrumental and cesarean deliveries5.

The question becomes, why is the all-fours position helpful, and since it is, why are not all women delivering this way? The explanation for why it is helpful probably lies in the increased freedom of movement within the pelvis. A woman’s pelvis is made of three sections, joined together by flexible cartilage, so that it can move easily. When a laboring woman lies on her back, her pelvis is constricted to a certain space. However, the all-fours position allows her pelvis to open 1-2cm, allowing adequate room for even a large baby to pass through6.

As for why this position is not used more frequently, the answer is complicated. Births that take place outside of the hospital generally result in this position being used more freqently, presumably because the mother is encouraged to choose the most comfortable position for her. Within the hospital, there may be several reasons for the lack of use of the all-fours position. These may include: patient risk factors that necessitate intervention, which is easier to use on a patient lying down, assumption that the patient is supposed to be on her back, preference of the hospital staff, or routine interventions (whether necessary or not) that require a lithotomy position.

An all-fours position may not be appropriate for all women. If she is tired, on pain meds, or has certain health conditions, lying on her side may be a better option for her.

Considering the definite benefits, however, all women should consider the all-fours position, among other upright positions, to be useful for them in labor and birth. Speak to your care provider to learn if this is a good option for you, and don’t be afraid to ask for a second opinion if your care provider is unfamiliar with this practice.

1, 6 – “A New (Old) Maneuver for the Management of Shoulder Dystocia” by Meenan, Gaskin, Hunt, and Ball. www.lifepassages.net/ShoulderDystocia.html

2 – www.consumerjusticegroup.com/birthinjury/paininback.html 3 – “Baby Malpositions: Implications for Birth” by KMom. www.plus-size-pregnancy.org/malpositions.htm#Strategies%20To%20Correct%20Malpositions

4, 5 – “A Meta-Analysis of Upright Positions in the Second Stage to Reduce Instrumental Deliveries in Women with Epidural Analgesia” by Roberts, Alger, Cameron, and Torvaldsen. Acta Obstet Gynecol Scan. 2005 Aug; 84(8):794-8.

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